VACANT/UNOCCUPIED PROPERTIES QUESTIONNAIRE
1.NATIONAL ACCOUNT NAME:
CHAPTER NAME: SCHOOL NAME:
HOUSE CORPORATION NAME:
2.THE BUILDING BECAME VACANT / UNOCCUPIED ON WHAT DATE?
3. THE BUILDING IS EXPECTED TO BE VACANT/UNOCCUPIED UNTIL?
4.ARE THERE PLANS TO LEASE YOUR BUILDING TO ANOTHER GROUP?
YES NO
PROPOSED LEASE EFFECTIVE DATE?
*THE PROPOSED LEASE MUST BE PROVIDED FOR UNDERWRITERS REVIEW*
A. FIRE PROTECTION INFORMATION:
THIS SYSTEM MUST BE MAINTAINED AND OPERATIONAL AT ALL TIMES!
1.THE TYPE OF FIRE/SMOKE DETECTION SYSTEM PRESENT AND OPERATIONAL IS?
BATTERYHARDWIRED WIRELESS/REMOTE
2. IS THE BUILDING EQUIPPED WITH A FIRE ALARM SYSTEM? YES NO
3. IS THE FIRE ALARM SYSTEM MONITORED? YES NO
4. NAME & PHONE NUMBER OF MONITORING COMPANY:
5.IS THERE A CONTRACT FOR ANNUAL INSPECTION/MAINTENANCE OF THESE SYSTEMS?
YES NO
COMPANY NAME & PHONE NUMBER:
DATE LAST INSPECTED:
B.AUTOMATIC SPRINKLER SYSTEM:
THIS SYSTEM MUST BE MAINTAINED AND OPERATIONAL AT ALL TIMES!
1.IS THERE AN AUTOMATIC FIRE SPRINKLER SYSTEM PRESENT AND OPERATIONAL?
YES NO
2.WHAT AREAS OF THE BUILDING ARE PROTECTED?
3.ARE ALL AREAS WITH WET SYSTEMS HEATED? HEAT MUST BE MAINTAINED!
YES NO
VACANT/UNOCCUPIED PROPERTIES QUESTIONNAIRE
4. WHAT CENTRAL STATION MONITORING COMPANY YOU ARE USING?
COMPANY NAME & PHONE NUMBER:
5.IS THERE A CONTRACT FOR ANNUAL INSPECTION/MAINTENANCE?
COMPANY NAME & PHONE NUMBER:
DATE LAST INSPECTED:
C.PROPERTY SECURITY & SUPERVISION :
1.WILL THERE BE A LIVE-IN CARETAKER?
YES NO
IF YES, WHO?
IF NO LIVE-IN CARETAKER IS PROVIDED, THE FACILITY MUST BE INSPECTED WEEKLY TO VERIFY THAT THE PROPERTY IS SECURE, THAT NO DAMAGE TO THE PROPERTY HAS OCCURRED, AND ALL UTILITIES AND LIFE SAFETY SYSTEMS ARE OPERATIONAL.
WHO IS RESPONSIBLE FOR MAKING AT LEAST WEEKLY CHECKS ON THE BUILDING?
NAME & PHONE NUMBERS:
2.IS THERE A WORKING SECURITY/BURGLAR ALARM?
YES NO
3.WILL THERE BE SECURITY FENCING AROUND BUILDING?
YES NO
4.WILL THE HOUSE BE BOARDED UP?
YES NO
D.MISCELLANEOUS:(IS THERE ANY FURTHER INFORMATION YOU WISH TO PROVIDE)
VACANT/UNOCCUPIED PROPERTIES QUESTIONNAIRE
**SHOULD ANY OF THIS INFORMATION CHANGE YOU AGREE TO NOTIFY US IMMEDIATELY! AS OUTLINED IN THE POLICY LANGUAGE ON PROTECTIVE SAFEGUARDS NOTED BELOW, YOUR COVERAGE IS VOID IF YOU FAIL TO COMPLY WITH THESE POLICY CONDITIONS. YOUR UNDERWRITERS MUST BE ADVISED OF AND AGREE TO ANY CHANGES IN THE PROTECTIVE SAFEGUARDS FOR YOUR PROPERTY**
PROTECTIVE SAFEGUARDS WARRANTY
This insurance does not apply to loss or damage caused by or resulting from fire if, prior to the fire, you:
1.Knew of any suspension or impairment in any protective safeguard or procedure listed in the Schedule above and failed to notify us of that fact; or
2. Failed to maintain any protective safeguard or procedure listed in the Schedule above, and over which you had control, in complete working order.
If part of an Automatic Sprinkler System is shut off due to breakage, leakage, freezing conditions or opening of sprinkler heads, notification to us will not be necessary if you can restore full protection within 72 hours.
PLEASE SIGN, DATE AND RETURN TO OUR OFFICE IMMEDIATELY
INFORMATION PROVIDED AND CONDITIONS AGREED BY:
SIGNATURE & TITLEDATE
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